Method of replacing an anterior cruciate ligament in the knee

ABSTRACT

A method of reconstructing a ruptured anterior cruciate ligament in a human knee. Femoral and tibial tunnels are drilled into the femur and tibia. A transverse tunnel is drilled into the femur to intersect the femoral tunnel. A filamentary loop is threaded through the femoral tunnel and tibial tunnel and partially through the transverse tunnel. A replacement graft is formed into a loop and moved into the tibial tunnels using a surgical needle and suture. A flexible filamentary member is simultaneously moved along with the loop into the femoral and transverse tunnels. The filamentary member is used as a guide wire in the transverse tunnel to insert a cannulated cross-pin to secure a top of the looped graft in the femoral tunnel.

TECHNICAL FIELD

The field of art to which this invention relates is arthroscopicsurgical procedures, in particular, arthroscopic surgical procedures forreplacing an anterior cruciate ligament in the knee.

BACKGROUND OF THE INVENTION

Arthroscopic surgical repairs of a ruptured anterior cruciate ligamentin the knee are known in this art. A rupture of the anterior cruciateligament (“ACL”) is often seen in sports related injuries. In a typicalarthroscopic procedure, the surgeon prepares the patient for surgery byinsufflating the patient's knee with sterile saline solution. Severalcannulas are inserted into the knee and used as entry portals into theinterior of the knee. A conventional arthroscope is inserted through oneof the cannulas so that the knee may be remotely viewed by the surgeon.The surgeon then drills a tibial tunnel and a femoral tunnel inaccordance with conventional surgical techniques using conventionalsurgical drills and drill guides. A replacement anterior cruciateligament graft is then prepared and mounted in the tibial and femoraltunnels, and secured using conventional techniques and known devices inorder to complete the ACL reconstruction.

Several types of anterior cruciate ligament grafts are available for useby the surgeon in ACL reconstruction procedures. The grafts may beautografts that are harvested from the patient, for example patellarbone-tendon-bone grafts, or hamstring grafts. Or the grafts can bexenografts, allografts, or synthetic polymer grafts.

There are various known methods for securing the femoral end of an ACLgraft in the femoral tunnel. The methods include, for example,cross-pinning, and the use of femoral tunnel interference screws. Ofparticular interest is a procedure wherein a cross-pin is used to securethe graft in the femoral tunnel. When such a device is used, atransverse tunnel is drilled into a section of the femur such that itintersects the longitudinal femoral tunnel. When using a conventionalcross-pinning technique, the surgeon typically prepares the graft byforming or folding it into a loop. Typically, this step is preceded bywhip stitching the ends of the graft in a conventional manner. After thetop end of the graft loop is emplaced in the femoral tunnel, a cross-pinis then inserted into the transverse tunnel and through the opening inthe loop of the graft underneath the top of the graft, thereby bothsecuring the graft in place in the femoral tunnel.

Although the existing methods of performing ACL reconstruction usingcross-pins are satisfactory for their intended purpose, and provide thepatient with the desired therapeutic result, there is a constant need inthis art for improved methods of performing ACL graft reconstructionusing cross-pins. In particular, one critical aspect of a cross-pinningmethod is the ability to place a graft in a femoral tunnel such thatwhen the cross-pin is inserted through the transverse tunnel, the pin isprecisely placed in the opening of the graft loop below the top of thegraft loop. It can be appreciated by those skilled in this art thatplacement of the cross-pin above the top of the graft loop will resultin the graft not being adequately secured in the femoral tunnel, withthe likelihood of a catastrophic failure. Precise placement of across-pin into the opening of a graft loop is presently accomplished inthis art by using guide wires and cannulated cross-pins that areinserted over the guide wires. In one known method, a guide wireconsisting of a flexible filamentary member is actually looped throughthe transverse tunnel and down through the femoral and tibial tunnels,such that an end extends out through both sides of the transversetunnel, and a bottom loop extends out through the bottom of the tibialtunnel. A graft is folded to form a graft loop and placed about thebottom loop of the guide wire such that the guide wire runs through thegraft loop opening. The ends of the guide wire extending out through theopenings of the transverse tunnel are tensioned to pull the guide wireand graft up through the tibial and femoral tunnels into a desiredposition for fixation, and a cannulated cross-pin is then threaded overthe guide wire and mounted in the transverse tunnel to secure the upperpart of the graft loop in the femoral tunnel. Although this methodsucceeds in emplacing a graft in the femoral tunnel and securing it witha cross-pin, there are disadvantages associated with its use. Forexample, it requires that the graft be pulled longitudinally through thetibial and femoral tunnels by pulling transversely on the flexiblefilamentary member ends that exit the sides of the transverse tunnel.This may result in damage to the bone surrounding the interiors of thefemoral and transverse tunnels. In addition, it can be a lengthy andtime-consuming process since it is inefficient to move a graftlongitudinally through a tunnel by pulling transversely on the flexiblefilamentary member.

Accordingly, there is a need in this art for improved methods of ACLknee reconstruction using cross-pins.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide a novel method ofperforming an ACL reconstruction using a cannulated cross-pin, wherein afilamentary member is provided as a guide for the cross-pin, and an ACLgraft is pulled into the tibial and femoral tunnels using a surgicalneedle and attached surgical suture.

Therefore, a method for repairing a knee arthroscopically using ananterior cruciate ligament replacement graft is disclosed. The methodconsists of providing an anterior cruciate ligament replacement graftthat is formed into a loop having a top and a bottom. The loop has anopening. A longitudinal tibial tunnel is drilled through a top of atibia adjacent to the knee, the tibial tunnel has top and bottomopenings. A longitudinal femoral tunnel is drilled through the bottomsection of an adjacent femor such that the tibial tunnel and the femoraltunnel are substantially in alignment. The femoral tunnel has opposedtop and bottom openings. A substantially transverse tunnel is drilledthrough the femoral tunnel such that the transverse tunnel intersectsthe femoral tunnel and is in communication therewith, the transversetunnel has opposed first and second openings. A filamentary member isprovided. The filamentary member is an endless loop. The filamentarymember is threaded through knee such that a first end loop of thefilamentary member extends out from a first side of the transversetunnel, continues through the femoral and tibial tunnels, and a secondend loop extends out through the bottom opening of the tibial tunnel. Asurgical needle and suture are provided. The suture is mounted to thesurgical needle such that a suture loop is formed. The graft is engagedwith the suture loop such that the suture passes through the graft loopopening. And, the graft is also engaged with the second end loop of thefilamentary member such that the filamentary member passes through thegraft loop opening. The needle and suture are moved into the tibialtunnel and femoral tunnel. The graft loop is pulled into and partiallyout of the tibial tunnel by pulling on the needle and suture, such thatthe top of the graft loop is located outside of the top opening of thetibial tunnel and adjacent to the bottom opening of the femoral tunnel.The needle and suture move out through the top opening of the femoraltunnel. The filamentary member simultaneously moves with the graft asthe suture is pulled. The second end loop of the filamentary member isalso located outside of the top opening of the tibial tunnel adjacent tothe bottom opening of the femoral tunnel. The first end loop of thefilamentary member is then cut to form first and second ends. The firstend of the filamentary member is maintained outside of the first openingof the tibial tunnel, and the filamentary member is manipulated toextend through the transverse tunnel with the second end of thefilamentary member extending out through the second opening of thetransverse tunnel. The suture is then tensioned to move the top of thegraft loop and the second end loop of the filamentary member into tofemoral tunnel such that the graft loop opening is in substantialalignment with the transverse tunnel. The filamentary member istensioned to form a substantially straight configuration that issubstantially in alignment with the transverse tunnel. A cannulatedcross-pin is provided. The upper end of the graft loop is secured in thefemoral tunnel by passing the cannulated bone pin over the filamentarymember and mounting the bone pin in the transverse tunnel. The lower endof the graft loop may be secured in the tibial tunnel by inserting asecurement member or device into the tibial tunnel, e.g. an interferencescrew, thereby completing the reconstruction.

These and other aspects, advantages of the present invention, willbecome more apparent from the following drawings and accompanyingdescription.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of a human knee having a ruptured anteriorcruciate ligament.

FIG. 2 is an illustration of the knee of FIG. 1 having tibial andfemoral tunnels drilled in the tibia and femor respectively, andillustrating a drill guide mounted to the knee for drilling a transversetunnel in the femor to receive a cross-pin.

FIG. 3 illustrates an instrument for inserting a looped filamentarymember into the tibial and femoral tunnels.

FIG. 4 illustrates the distal end of the loop insertion instrument inthe femoral tunnel with a passing pin inserted into the transversetunnel.

FIG. 5 illustrates the passing pin capturing a looped segment of thefilamentary member from the loop insertion instrument as the loopinsertion instrument is withdrawn from the femoral tunnel.

FIG. 6 illustrates the distal end of the passing pin extending outthrough one end of the transverse tunnel, and the loop segment exitingthe transverse tunnel.

FIG. 7 illustrates the knee with a surgical suture loop threaded throughthe tibial and femoral tunnels, and a graft looped segments of thefilamentary member and the suture extending out from the bottom of thetibial tunnel; the passing pin has been moved laterally in thetransverse to a side of the femoral tunnel.

FIGS. 8 a-c illustrates the graft moved into a position extending outfrom the tibial tunnel adjacent to the entrance to the tibial tunnel,with the top loop segment being cut with surgical scissors and one endbeing threaded into openings in the passing pin member.

FIG. 9 illustrates the passing pin moved through the transverse tunnel,with the looped segment cut and having a first cut end mounted to thedistal end of the passing pin prior to moving the passing pin and endthrough the transverse tunnel, while the second cut end is free.

FIG. 10 illustrates the first and second ends of the filamentary memberexiting opposite sides of the transverse tunnel with a bottom loopsegment extending out through the bottom opening of the femoral tunnelwith the top of the graft adjacent to the bottom opening of the femoraltunnel; the passing pin has been removed from the transverse tunnel.

FIG. 11 illustrates a section of the suture exiting the femoral tunnelwith the graft member moved into and positioned within both the femoraland tibial tunnels, having the top end of the graft emplaced in thefemoral tunnel such that the graft loop opening adjacent to thetransverse tunnel. Also shown is the filamentary member being tensionedto straighten and align it with the transverse tunnel to serve as aguide wire.

FIG. 12—illustrates a cannulated cross-pin inserted over the guide wireand partially inserted into the transverse tunnel.

FIG. 13 illustrates the cross-pin partially inserted with the distal endin the graft loop opening and underneath the top of the graft loop.

FIG. 14 illustrates the cannulated pin completely screwed into place andengaging the graft and securing the upper end of the graft in asubstantially fixed position in the femoral tunnel.

FIG. 15 illustrates the knee after the top end of the end of the grafthas been secured in the femoral tunnel and the guide wire removed, andwith the bottom end of the graft secured in the tibial tunnel using aninterference screw, thereby completing the ACL replacement surgicalprocedure with the ACL replacement graft secured in both the femoral andtibial tunnels to provide for a reconstructed ACL.

DESCRIPTION OF THE INVENTION

The terms “anterior cruciate ligament” and the acronym “ACL” are usedinterchangeably herein.

Referring now to FIGS. 1-15, the novel surgical method of the presentinvention of replacing a ruptured anterior cruciate ligament toreconstruct a knee is illustrated. FIG. 1 illustrates a typicalpatient's knee 5 prior to the onset of the surgical procedure.Illustrated is the top 15 of the tibia 10, the top 21 of the fibula 20,the bottom 61 of the femur 60, as well as the condylar notch 65. Theposterior collateral ligament 50 is seen to be present in the knee 5.Also seen at the top 15 of the tibia 10 the meniscal cartilage 22.

As seen in FIG. 2, after preparing the patient's knee 5 usingconventional arthroscopic surgical procedures, a tibial tunnel 40 isdrilled in a conventional manner through the top 15 of the tibia 10 tocreate tibial tunnel 40. Tibial tunnel 40 has passage 41 having loweropening 43 and upper opening 45. The tibial tunnel 40 is drilled using aconventional two-step process with an initial pilot guide drill followedby a subsequent coring reamer to create the tibial tunnel 40 havingpassage 41. Preferably, the tibial tunnel is positioned in the posteriorone-half of the normal attachment site of the ACL. The tunnel 40 istypically debrided of all surrounding debris at lower opening 43 andupper opening 45, and any sharp edges are chamfered using a conventionalbone rasp. Next a conventional offset femoral aiming device (not shown)is inserted through opening 43 and into the tibial tunnel 40 such thatthe distal end of the femoral aimer device extends out through theopening 45 at the top of the tunnel 40, and the distal end of thefemoral aimer device engages a suitable position on the superior rim 66of the condylar notch 65. Then a guide pin can be drilled up through thenotch 65 and out of the anterior cortex 67 of the femur 60. Next afemoral tunnel 90 is reamed out using a conventional surgical reamer toaccommodate the graft diameter. The femoral tunnel 90 is seen to havebottom opening 91, passage 95 and top opening 92. The tunnel is seen tohave internal step 93 where the passage 95 transitions between firstdiameter 96 and second diameter 97. The tunnel 90 is typically debridedof all surrounding debris at bottom opening 91 and top opening 92, andany sharp edges are chamfered using a conventional bone rasp.

Next, a transverse femoral drill guide 120 is mounted to the tibia 10and the femur 60. The drill guide 120 is seen to have “L” shaped frame122 having bottom leg 126 and perpendicular top leg 128. The drill guide120 is seen to have longitudinal drill guide 130 mounted to the bottomleg 126 and horizontal drill guide 140 mounted to the top leg 128. Thelongitudinal drill guide 130 is positioned within the tibial and femoraltunnels 40 and 90, respectively. A partial incision 141 is made in theskin and the tissue thereunder is bluntly bisected to the lateralfemoral cortex 68. The drill guide 140 is advanced to contact thelateral femoral condyral 69. Next, a drill 145 is inserted into thetransverse drill guide 140 and the transverse tunnel 150 is drilledtransversely through the femoral end 61. The distal end section 132 ofthe longitudinal drill guide 130 contains an opening 134 to receive thedrill 145 to provide for appropriate alignment. The tunnel 150 is seento have passage 155, and opposed end openings 151 and 152. The knee 5 isnow ready to have the replacement ACL graft implanted.

The types of ACL implants that can be used in the method of the presentinvention include autografts, allografts, xenografts and syntheticgrafts. Autografts consists of the patients own ligamentous tissueharvested either from the patellar tendon or from the tendons of thehamstring. Allografts include ligamentous tissue harvested from cadaversand appropriately treated and disinfected, and preferably sterilized.Xenografts include harvested connective tissue from animal sources suchas, for example, porcine tissue. Typically, the xenografts must beappropriately treated to eliminate or minimize an immune response.Synthetic grafts include grafts made from synthetic polymers such aspolyurethane, polyethylene, polyester and other conventionalbiocompatible bioabsorbable or nonabsorbable polymers and composites.The grafts 200 are typically prepared in a conventional manner,optionally whip stitching the ends 212 of the graft with surgicalsutures 220, and folding the graft over by bringing the ends 212together to form a loop of graft material having a bottom 215, a looptop 222 and a loop opening 225 as seen in FIGS. 9-14.

The filamentary members 180 that may be used in the practice of thepresent invention include any type of flexible, strong biocompatiblematerial. The filaments may be a single unitary fiber or may be ofmulti-filament construction, for example, braided or woven. Thefilaments may be made from nylon, polypropylene, polyethylene,polyester, braided, woven and twisted metal and/or malleable alloys andcombinations thereof. In a particularly preferred embodiment, thefilamentary member 180 is made from nylon. The filamentary member 180may be precut with two opposed ends, or may be in the form of an endlessloop. It is particularly preferred in the practice of the presentinvention to utilize the filamentary member in the form of an endlessloop that is later cut to provide a filamentary member with two ends.

When using a filamentary member 180 in the surgical method of thepresent invention it is preferably used in the form of an endless loop(see FIGS. 3-11). The filamentary member is loaded on to an inserterinstrument 240 having a proximal handle 242 and a distal notched end 244for engaging the loop. The distal notched end 244 of the inserter 240having the filamentary member 180 mounted thereto is then inserted intothe bottom opening 43 of the tibial tunnel 40 and the instrument ismoved forward through the passage 41 of tibial tunnel 40, out of upperopening 45, through bottom opening 91 of femoral tunnel 90 and into thepassage 95 of femoral tunnel 90 adjacent to the intersection with thetransverse tunnel 150. Then, a passing pin member 250 is inserted intoopening 152 of the transverse tunnel. The passing pin 250 is seen tohave a notch 252 for receiving and engaging a section of the filamentaryloop member 180. The passing pin 250 is seen to pass through opening 246in notched end 244. Once a section of the member 180 is engaged orcaptured in the notch 252, the inserter member 240 is withdrawn from thefemoral and tibial tunnels 40 and 90, respectively, and the shuttleinstrument 250 is moved laterally until the notch 252 and the engagedsection of the filamentary member 180 exits opening 151 of thetransverse tunnel 150. At that time, the first top loop section 185 ofmember 180 is removed from the notch 252 by the surgeon and ismaintained outside of opening 151. the bottom loop section 187 of thefilamentary member 180 is seen to extend down out through the bottom ofthe tibial tunnel 40 through opening 43. A surgical suture 260 is thenused to move the graft 200 into place in the tibial and femoral tunnels40 and 90, respectively. The surgeon loops or folds the graft 200through the opening 266 of suture loop 265 of suture 260 connected tothe proximal end 282 of the straight surgical needle 280. Needle 280 hasdistal end 285. The suture passes through the eyelet 283 of the needle280. At the same time the tendon graft 200 is also looped through theopening 186 of bottom section loop 187 of the filamentary member 180.The surgeon then pulls the straight surgical needle 280 up in thedirection along the longitudinal axes of the femoral and tibial tunnels40 and 90, respectively, such that the needle 280 exits the femoraltunnel 90 through top opening 92, and the suture loop pulls the distalor top end 222 of the graft loop 200 out of the tibial tunnel andadjacent to opening 91 of femoral tunnel 90. As the suture 260 pulls thedistal end 222 of the graft 200 into and out of the tunnel 40, thelooped end 185 of the filamentary member 180 also moves with the top end222 of graft 200 into the space adjacent to the opening 91 of femoraltunnel 90.

Next, the surgeon cuts the top loop section 185 with conventionalsurgical scissors 400 to form ends 181 and 182. End 182 of the member180 is then threaded into the eyelets 256 and the passing pin member 250is moved horizontally in the opposite direction through passage 155 oftransverse tunnel 150 exiting the transverse tunnel through opening 152on the opposite side of tunnel 150 such that the end 182 also exits thetunnel, and the ends 181 and 182 of the filamentary member 180 exitthrough opposite sides of the transverse tunnel 150 (through openings151 and 152, respectively). The passing pin member 250 is removed fromthe transverse tunnel 150. Needle 280 and suture 260 are then tensionedand moved through femoral tunnel 90 such that the top section of graft200 is moved into femoral tunnel 90 and the graft top end 222 is locatedin the femoral tunnel 90 in a fixation position, with opening 225 inalignment with passage 155. The ends 181 and 182 of the filamentarymember 180 are tensioned to place the filamentary member 180 in astraight configuration to serve as a guide wire through transversetunnel 150 and through graft opening 225 for a conventional cannulatedcross-pin.

Referring now to FIGS. 12-15, the cross-pin 300 is seen to have lumen305 and threaded bone engaging section 307. The end 181 of thefilamentary member 180 is threaded through lumen 305 of cannulatedcross-pin 300, and secured in the handle 325 of the driving instrument320 by attachment to the optional bead member 330 having passages 332for receiving the end 181. Bead member 330 is mounted to the end ofhandle 325. The other end 182 of the filamentary member 180 is placed intension by the surgeon while the surgeon screws the cross-pin into thetunnel 150 underneath the top 222 of the graft loop 200 and throughopening 225 thereby securing the upper section of the graft 200 in thefemoral tunnel 90. The surgeon then removes the driving instrument 320from the cross-pin 300, and removes the instrument 320 and filamentarymember 180 from the transverse tunnel 150 and the cross-pinningprocedure is complete, with the top end 222 of the ACL replacement graft220 substantially secured or fixed in femoral tunnel 90. Shown if FIG.11 is the optional depth stop sleeve 390 used to assure the surgeon thatthe threads 307 are flush against the lateral femoral cortex 68 orslightly buried.

The surgeon then affixes the bottom end 215 of the graft 200 in thetibial tunnel 40 using a conventional securing device such as aninterference screw 340, or other conventional devices such as tibialfasteners, screws and washers, etc. The ACL replacement is now complete,and the surgeon can remove the cannulas and close the incisions aboutthe knee using conventional incision approximating techniques includingsutures, tape, glue, staples, etc.

The cross-pins useful in the present invention can be made from avariety of conventional biocompatible materials useful in implants. Thematerials may be absorbable or non-absorbable. Examples of conventionalnon-absorbable materials include surgical stainless steel, nickeltitanium alloys, ceramics, Delrin, polyethylene, and othernon-absorbable polymers including, but not limited to, polypropylene,and Acetal. Examples of bioabsorbable materials include PLA, PGA,polydioxanone, polycaprolactone, copolymers thereof, and the like. Theterm “natural polymer” refers to polymers that are naturally occurring,as opposed to synthetic polymers. In embodiments where the deviceincludes at least one synthetic polymer, suitable biocompatiblesynthetic polymers can include polymers selected from the groupconsisting of aliphatic polyesters, poly(amino acids),copoly(etheresters), polyalkylenes oxalaes, polyamides, tyrosine derivedpolycarbonates, poly(iminocarbonates), polyorthoesters, polyoxaesters,polyamidoesters, polyoxaesters containing amine groups,poly(anhydrides), polyphosphazenes, polyurethanes, poly(etherurethanes), poly(ester urethane) and blends thereof. Suitable syntheticpolymers for use in the present invention can also include biosyntheticpolymers based on sequences found in collagen, elastin, thrombin,fibronectin, starches, poly(amino acid), poly(propylene fumarate),geletin, alginate, pectin, fibrin, oxidized cellulose, chitin, chitosan,tropoelastin, hyaluronic acid, ribonucleic acids, deoxyribonucleicacids, polypeptides, proteins, polysaccharides, polynucleotides andcombination thereof. The devices of the present invention may also bemanufactured from conventional biocompatible natural polymers. Ifdesired, the bioabsorbable materials may contain osteoinductive orosteoconductive materials, polymers and blends of polymers including butnot limited to calcium hydroxyapatite, tricalcium phosphate, and thelike.

The cross-pins of the present invention may be made using a variety ofconventional manufacturing processes including machining, molding, etc.,and combinations thereof.

The novel anterial cruciate ligament replacement procedure of thepresent invention has improvements over procedures known in the art. Inparticular, the combination of the needle and suture to pull the graftinto the femoral tunnel along with the suture loop filamentary member toprovide for a transverse guide wire provides efficiency in the placementof the top of the graft in the femoral tunnel while minimizing oreliminating damage to the bone in the transverse tunnel that could becaused by pulling up the graft using the filamentary member. At the sametime that the graft is emplaced in the femoral tunnel, the filamentarywire is in place in the transverse tunnel to serve as a guide wire foremplacing the cross-pin in the transverse tunnel and through the openingin the graft loop.

Although this invention has been shown and described with respect todetailed embodiments thereof, it will be understood by those skilled inthe art that various changes in form and detail thereof my be madewithout departing form the spirit and scope of the claimed invention.

1. A method of repairing a knee, comprising: providing an anteriorcruciate ligament replacement graft having opposed ends; drilling alongitudinal tibial tunnel through a top section of a tibia, the tibialtunnel having a top opening and a bottom opening; drilling alongitudinal femoral tunnel through a bottom section of an adjacentfemur such that the tibial tunnel and the femoral tunnel aresubstantially in alignment, wherein said femoral tunnel has a bottomopening and a top opening; drilling a substantially transverse tunnelthrough the femoral tunnel, such that the transverse tunnel intersectsthe femoral tunnel, and is in communication therewith, the transversetunnel having first and second open ends; providing a filamentarymember, wherein said filamentary member comprises an endless loop;threading the filamentary member through the knee such that a first loopsegment of the filamentary member extends out from one end of thetransverse tunnel and a second loop segment of the filamentary memberextends out through a bottom opening of the tibial tunnel; providing asurgical needle and attached surgical suture; folding the graft to forma graft loop having a top, a bottom, and an opening; engaging the graftwith the suture such that the suture passes through the graft loopopening; engaging the graft with the filamentary member such that itpasses through the graft loop opening; pulling the graft loop up andinto the tibial tunnel by pulling on the needle and suture, such thatthe top of the graft is outside of the tibial tunnel adjacent to thebottom opening of the femoral tunnel, and the second loop segment of thefilamentary member is also outside of the tibial tunnel; adjacent to thebottom opening of the femoral tunnel cutting the first loop segment ofthe filamentary member to form first and second ends, and manipulatingthe filamentary member to extend completely through the transversetunnel such that the first end of the filamentary member extends outfrom the first open end of the transverse tunnel and the second end ofthe filamentary member extends out from the opposed second open end ofthe transverse tunnel; pulling the top section of the graft into thefemoral tunnel by pulling on the needle and suture such that the graftloop opening is in alignment with the transverse tunnel; manipulatingthe filamentary member such that it is tensioned to form a substantiallystraight configuration that is substantially in alignment with thetransverse tunnel; providing a cannulated bone cross-pin having an outersurface; and, securing the upper end of the graft loop in the femoraltunnel by passing the cannulated cross-pin over the filamentary memberand through the graft loop opening, and mounting the cross-pin in thetransverse tunnel.
 2. The method of claim 1 additionally comprising thesteps of providing a tibial securement member and securing the lower endof the graft loop in the tibial tunnel by inserting the securementmember into the tibial tunnel.
 3. The method of claim 1 wherein thecannulated cross-pin comprises at least one section of threads on itsouter surface.
 4. The method of claim 1, wherein the cannulatedcross-pin comprises an absorbable polymer.
 5. The method of claim 1,wherein the cannulated cross-pin comprises a biocompatible metal.
 6. Themethod of claim 1, wherein the cannulated cross-pin comprises abiocompatible material selected from the group consisting of allograftbone, autograft bone, ceramics and composites.